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Friday, July 24, 2015

Skin conditions in companion animals can be a source of
frustration, for the animal, the owner and even the veterinarian. If you’ve
ever lived with a dog or cat that is scratching or licking 24/7, comes out in
welts every time he or she goes for a walk, or has seemingly never-ending ear
infections you know the pain. Owners are often at their wit’s end, and just
want and end to it – but treatment can take time.

On the flip side, if you can help manage skin disease,
you can improve an animal’s quality of life massively.

In today’s post, top veterinary dermatologists share
their tips for veterinarians managing skin conditions in general practice. They
happen to be gathering in Australia in September at the CVE’s clinical
dermatology conference in Port Douglas. If you want to find out more about
evidence based dermatology and current controversies in the field, while
scratching your itch to travel, find out more here.

Empathise: take time to work out your client
and what they can and cannot understand and can and cannot do. Ask them to tell
their story.

Communication: the challenge and success as
well as the rewards of chronic care management for most dermatologic conditions
in dogs and cats is based in the successful communication of clear expectations
to clients; this does not mean that expectations should be low, but there has
to be an understanding that chronic skin diseases require both short and
long-term planning for successful outcomes. Share the plan in different
ways; talk about it, draw it on the white board, write it down to take home and
then have your staff call and talk it over a few days later. Make sure that you
have an adequate follow-up system in place so that skin cases attend their
scheduled revisit appointments.

Topical therapy: in many instances, topical therapy
for allergic and infected skin disease is of significant value but overlooked;
in areas of regional pruritus such as ears and feet, the application of modern
“soft” steroids and topical antibacterial products are a valuable tool for long
term management of atopic dogs with minimal adverse effects; these products are
very helpful in reducing reliance on systemic antimicrobial agents,
glucocorticoids and other immunomodulatory drugs. Before you prescribe, stop
and think! Could I reduce my reliance on systemic drugs for this patient by
combining some topical therapy?

Allergic conjunctivitis is often overlooked in
atopic dogs as pruritus is not always present. Allergic conjunctivitis can
cause tear film abnormalities and progress to corneal (vision threatening) disease.
Continuous maintenance therapies with antihistamine drops can be safe and
effective. Systemic absorption from ocular steroid containing drops can be
clinically significant in small breed dogs.

Denial is MRSP’s (Multiresistant Staphylococcus pseudintermedius –
formerly known as MRSI) best friend. Consider MRSP in every dog with
persistence of bacterial pyoderma in the face of compliant beta lactam
antimicrobial therapy. Culture early, specifically ask the laboratory to look
for MRSP and ensure post-consultation hygiene measures are adequate in-clinic (room and staff). F10
disinfection of the room and 70% alcohol on all washable surfaces (including
computer keyboards) and effective hand washing before re-using the consulation
room can limit spread of MRSP within the clinic.

Dr
Rusty Muse DVM Diplomate ACVD
MANZCVS

Spend the time to take a complete history regarding
the skin disease present. The skin has limited reaction patterns so the
history of a patient and its skin disease including how it started, how it has
progressed, the areas affected and response to therapy will give you most of
the information that you will need to know to proceed with accurate diagnostics
and therapeutics.

Pursue underlying primary diseases when secondary
problems present. Bacterial orMalasseziainfections whether of the skin or
the ear have a primary cause in most every case. Develop a plan to pursue
or manage the primary disease because if you don’t relapsing infections whether
skin or ears will cause you to lose clients.

There is no substitute for clear, concise and very
detailed discharge instructions in managing skin disease. Most clients
will follow your instructions if they know what is expected of them. It is
imperative in most cases of skin disease, that clients continue therapy until
remission or control of the condition has been achieved and then a long term
management plan can be instituted on follow up visits.

Dr Wayne Rosenkrantz DVM Diplomate ACVD

When dealing with
the pruritic dog, keep in mind the four most common causes of pruritus (Atopic
dermatitis, Flea allergy, Adverse food reactions and Scabies). Correlate the
diseases by emphasis on history and physical lesion distribution.

Eliminate simple
things first when approaching chronic inflammatory skin disease. The most common
component of pruritus in dogs with chronic inflammatory skin disease is
microbial disease; therefore, this should be tested for first with cytology. In
atopic dermatitis cases, secondary pyoderma is present in approximately 80% of
the cases and Malassezia in 35%. It may be even more prevalent based on how
aggressively one looks for secondary infections.

Veterinary Ethics: Navigating Tough Cases

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